The Experience of Cancer Stigma in Taiwan: A Qualitative Study of Female Cancer Patients

Study on the Profiles of Sleep Disorders, Associated Factors, and Pathways Among Gynecological Cancer Patients - A Latent Profile Analysis

Background

Gynecological cancer generally refers to malignant tumors in gynecology, commonly including cervical cancer, endometrial cancer, and ovarian cancer. Patients with gynecological cancer often suffer from sleep disorders after clinical treatment. Except for serious sleep disorders, female characteristics, family roles, and feudal beliefs make their self-stigma at a medium to high level, leading to huge pressure. This study aims to identify potential categories of sleep disorders, and analyze the relationship between self-stigma, perceived stress, and sleep disorders.

Methods

A cross-sectional study was conducted in 2021-2022. Two hundred and two patients' data were collected from ShengJing Hospital Affiliated to China Medical University in Liaoning, Shenyang by using paper questionnaires for face-to-face surveys. The survey tools included the Pittsburgh Sleep Quality Index (PSQI), the Perceived Stress Scale (PSS), and the Social Impact Scale (SIS). Potential profile analysis (LPA), multiple logistic regression analysis, and structural equation modeling (SEM) were performed by Mplus 8.3, SPSS 26.0, and Amos 24.0 statistical tools, respectively.

Results

Three latent patterns of sleep disorders were found: "Good Sleep group (42.5%)", "Sleep Deficiency group (32.4%)", and "Sleep Disturbance group (25.1%)". Patients with high perceived stress were more likely to report a moderate (OR=1.142, 95% CI: 1.061-1.230) or high (OR=1.455, 95% CI: 1.291-1.640) level of sleep disorders. Self-stigma did not have a direct effect on sleep disorders (0.055, P>0.05), but it could have indirect effect on sleep disorders through perceived stress (0.172, P<0.01).

Conclusion

The perceptions of sleep disorders among gynecological cancer patients varies and exhibits individual differences. Gynecological cancer patients who feels alienated or discriminated may cause high pressure. This internal pressure can exacerbate sleep disorders.

Refinement of a Meaning-Centered Counseling Program for Chinese Patients with Advanced Cancer: Integrating Cultural Adaptation and Implementation Science Approaches

Background: This mixed methods study identified needed refinements to a telehealth-delivered cultural and linguistic adaptation of Meaning-Centered Psychotherapy for Chinese patients with advanced cancer (MCP-Ch) to enhance acceptability, comprehensibility, and implementation of the intervention in usual care settings, guided by the Ecological Validity Model (EVM) and the Practical, Robust Implementation and Sustainability Model (PRISM). Methods: 15 purposively sampled mental health professionals who work with Chinese cancer patients completed surveys providing Likert-scale ratings on acceptability and comprehensibility of MCP-Ch content (guided by the EVM) and pre-implementation factors (guided by PRISM), followed by semi-structured interviews. Survey data were descriptively summarized and linked to qualitative interview data. Three analysts independently coded the transcripts according to EVM and PRISM domains; discrepancies were resolved through discussion and consensus. Results: Quantitative findings showed high appropriateness and relevance of MCP-Ch across five EVM domains of Language, Metaphors/Stories, Goals, Content, and Concepts. Qualitative analysis yielded 23 inductive codes under the seven EVM domains: (1) Language (3 subcodes), (2) Persons (2 subcodes), (3) Metaphors/Stories (2 subcodes), (4) Methods (8 subcodes), (5) Content (2 subcodes), (6) Goals (4 subcodes), and (7) Concepts (2 subcodes). Themes based on PRISM included (1) Intervention characteristics (organizational perspective, 7 subcodes; and patient perspective, 6 subcodes) (2) External environment (2 subcodes), (3) Implementation and sustainability infrastructure (4 subcodes), and (4) Recipients (organizational characteristics, 5 subcodes; and patient characteristics, 4 subcodes). Conclusion: Recommendations for next steps include increasing the MCP-Ch protocol's flexibility and adaptability to allow interventionists to flexibly tailor MCP-Ch material to meet patients' individual needs, simplifying content to improve comprehension and acceptability, providing additional training to Chinese-serving providers to increase adoption and sustainability, and considering interpreter-assisted delivery to increase access. Findings yielded important information to maximize cultural relevance as well as the implementation and sustainability potential of MCP-Ch in real-world settings.

Effects of phytoncide on immune cells and psychological stress of gynecological cancer survivors: randomized controlled trials

This study aimed to identify neuroendocrine substances and natural killer (NK) cells, including their subsets and receptors, to determine whether phytoncides scented in an urban hospital could help improve stress in cancer survivors. Fifty-five gynecological cancer survivors were assigned to either the control group (CG, n=28) or phytoncide group (PTG, n=27). The PTG meditated by lying down in a space scented with phytoncide for 1 hr a day, 5 days a week for 8 weeks. Stress levels in both groups were high prior to the experiment and decreased by 9.31%±45.98% (P=0.003) only in the PTG after the experiment. Although the parasympathetic nerve activity of the PTG increased, the epinephrine and cortisol levels were significantly (P<0.001) decreased by 5.29%±25.5% and by 24.94%±11.62%. Moreover, the PTG showed a significant increase in the levels of NK cell subsets after 8 weeks, whereas there was no improvement in the CG. In conclusion, phytoncide fragrance reduces stress, increases the number of NK cells and their family even in a nonforest environment, and improves innate immunocytes in gynecological cancer survivors; parasympathetic nerve activity and cortisol hormones play critical roles in this process. That is, a phytoncide essential oil helps to stimulate changes in immunocytes' mobility by affecting the human nervous and endocrine systems, thereby providing relief for psychological stress among cancer survivors who previously had cancer cells.

Experiences of Muslim women living with gynaecological cancer and family caregivers

BACKGROUND

Cancer has a large impact on the life of the diagnosed person and also their caregivers, who are typically family members. The impact of cancer on a Muslim woman and her caregivers has not been well researched because of cultural and social constraits.

AIMS

The aim of this study was to explorel the experiences of Muslim women with gynaecological cancers and their family caregivers.

METHODS

A descriptive phenomenological approach was adopted. A convenience sample was used in the research.

FINDINGS

The study findings were grouped into four major themes: the initial reaction to a cancer diagnosis from women and their caregivers, difficulties the patient and caregiver experienced (physiological, psychological, social and sexual), coping with cancer and expectations that caregivers and patients have of the institution and the health personnel. It was determined that during this disease and treatment, both the patients and caregivers faced difficulties, which can be categorised as physiological, psychological, social and sexual. Muslim women with gynaecological cancer frequently used coping behaviours, such as worshiping and believing that illness and healing come from God during the illness process.

CONCLUSIONS

Patients and their family caregivers lived through various difficulties. Healthcare professionals need to consider the expectations of patients with gynecological cancer, alongside those of their family caregivers. Nurses can help Muslim patients and their families cope with the problems they experience by being aware of the positive coping methods of Muslim cancer patients and their caregivers. Nurses should consider individuals' religious beliefs and cultural differences while giving care.

The prevalence of depression and suicidal ideation among cancer patients in mainland China and its provinces, 1994-2021: A systematic review and meta-analysis of 201 cross-sectional studies

To evaluate the national prevalence depression of Chinese cancer patients and clarify its potential associated factors. Twelve databases were searched from database inception through October 31, 2022 for relevant studies published in English (PubMed MEDLINE, Ovid MEDLINE, Embase, Scopus, PsycINFO, and Cochrane and Web of Science) and Chinese (China National Knowledge Infrastructure, Wanfang, Weipu, Chinese Biomedical Literature Service System, Duxiu) that estimated point or period prevalence of depression, depressive disorder, or suicidal ideation as assessed by self-report scale or structured interview. 201 studies were eligible for inclusion in our meta-analyses. We found the national pooled prevalence rates of depression and suicidal ideation were 44.63 % (95 % CI 42.24 %-47.01 %) and 24.95 % (95 % CI 10.96 %-38.95 %), respectively. The pooled prevalence of depression was associated with study location, cancer type, comorbid chronic disease, and female sex (all P < 0.05). The distribution of the depression prevalence among cancer patients in mainland China was characterized by significant geographical variation and clustering. The highest pooled prevalence of depression was among gynecologic oncology patients. We recommend that more attention and resources be given to mental health problems such as depression and suicidal ideation among Chinese cancer patients, and that prevention programs be developed, especially in areas with a high prevalence of depression.

Living experiences of people with advance cancer with low socioeconomic status: A systematic review of qualitative evidence

BACKGROUND

The number of patients with advanced cancer is rapidly increasing, and the subgroup of this population with low socioeconomic status has suffered more disease burden than others. However, there is no recent qualitative synthesis of primary research studies into advanced cancer patients with low socioeconomic status.

OBJECTIVE

To synthesise qualitative research findings into advanced cancer patients' experiences with low socioeconomic status, and then to help provide targeted and effective strategies to improve their quality of life.

DESIGN

A systematic review and meta-synthesis of qualitative evidence (PROSPERO: CRD42021250423).

DATA SOURCES

PubMed, Web of Science Core Collection (ISI Web of Science), Cochrane Library, Embase, OVID LWW, CINAHL Complete (EBSCO), PsycINFO (EBSCO) and MEDLINE (ISI Web of Science), China National Knowledge Infrastructure (CNKI), WangFang, and Vip databases were systematically searched from their original dates to July 2022. Qualitative data were appraised using the Joanna Briggs Institute (JBI) qualitative assessment.

FINDINGS

The findings were synthesised into the following three analytical themes: (1) multi-dimensional disease distresses; (2) barriers in coping with disease distresses; and (3) strategies for dealing with disease distresses.

CONCLUSIONS

Patients with advanced cancer with low socioeconomic status experienced complicated and interactional distresses, unique life barriers, and a wide range of adaptation strategies. These findings will provide a comprehensive perspective to promote individual-centred health care systems and services to help these vulnerable people deal with the challenges of disease and improve their quality of life.

Return to Work and Mortality in Breast Cancer Survivors: A 11-Year Longitudinal Study

Breast cancer is the most commonly occurring cancer in women, and it is a major cause of cancer death around the world. With the development of diagnostic methods and improvements in treatment methods, the incidence rate of breast cancer and the number of breast cancer survivors continue to simultaneously increase. We used national registry database to analyze the features that affect employment and return to work among breast cancer survivors. A total of 23,220 employees, who were newly diagnosed with breast cancer were recruited based on the Labor Insurance Database (LID), the Taiwan Cancer Registry (TCR), and National Health Insurance Research Database (NHIRD) during the period 2004-2015. The correlations between return to work (RTW) and independent confounding factors were examined using Cox proportional hazards model. Survival probability was analyzed using the Kaplan-Meir method. After adjusting for confounding variables, cancer stage, chemotherapy and higher income were significantly negatively correlated with RTW. Among breast cancer survivors, RTW was found to be related to a lower risk of all-cause mortality in both the unadjusted and fully adjusted model. Patients who had RTW exhibited better survival in all stages. Work-, disease- and treatment-related factors influenced RTW among employees with breast cancer. RTW was associated with better breast cancer survival. Our study demonstrates the impact of RTW and the associated factors on breast cancer survivorship.

The association between comorbidities and stigma among breast cancer survivors

This study aimed to explore the association between types and numbers of comorbidities and stigma among breast cancer survivors (BCSs). A cross-sectional study was conducted among 937 BCSs in Shanghai Cancer Rehabilitation Club. All participants were asked to fill in an online questionnaire including Stigma Scale for Chronic Illnesses 8-item version (SSCI-8) and questions on sociodemographic characteristics and health status. Multivariate linear regression was used to analyze the association between comorbidities and stigma, adjusting for confounding factors. Results showed that nearly 70% of the participants had one or more comorbidities. The participants with stroke, digestive diseases or musculoskeletal diseases had significantly higher stigma than those without the above comorbidities. In addition, stigma was higher among survivors in the group with a greater number of comorbidities. Thus, it is important to strengthen the management of stigma in BCSs, especially for those with comorbidities.

Demoralization level fluctuated at various time frame of radiotherapy for patients with different cancers: a longitudinal observational study

Background

Demoralization is a psychological response that is frequently observed in patients with cancer or advanced diseases. It is affected by national characteristics, culture, disease characteristics and general conditions of the patient such as individual cultural features, nature of stress, personal expression preferences and social behavior. Compared with the results of previous studies on demoralization syndrome, patients with cancer in Taiwan exhibit a higher prevalence of demoralization. We aimed to investigate the prevalence of high demoralization and the changes in the level of demoralization in cancer patients during radiotherapy to explore the associated factors and the contributing factors to the high level of demoralization.

Methods

We used the Demoralization Scale-Mandarin Version to evaluate the demoralization level at six-time points in patients admitted for radiotherapy in a 3-month observational period. 101 patients allocated to three groups by cancer region completed the study. We applied the generalized estimating equation (GEE) to analyze the changes in the demoralization level among the three groups. The variables associated with the changes in the demoralization level were also investigated.

Results

In the analysis using univariate GEE, only patients in the chest and breast group exhibited significant changes at two different time points. The results obtained using multivariate GEE revealed that sociodemographic variables, stage of disease and use of surgery or chemotherapy had no impact on the changes in demoralization across three months.

Conclusion

The demoralization level certainly fluctuated in an extremely high range. The higher prevalence of demoralized patients may indicate that if medical staff neglect the importance of demoralization, demoralized patients with cancer may not receive appropriate care.

Coping with Stress in Neoplastic Diseases

Introduction: Disease-related stress is a common phenomenon. It also occurs in neoplastic diseases. Since physical and mental health are interrelated, it is important to make sure that treatment covers these two areas. Therefore, it is essential to learn how patients with neoplastic diseases can cope with stress. Materials and Methods: The respondents are 306 patients suffering from neoplastic diseases, associated in patient advocacy groups. The method is the Brief-COPE (Coping Orientation to Problems Experienced) questionnaire. Results: The following stress management strategies were most commonly adopted by the patients: acceptance (median 2.25; 25−75% IQR 2.0−3.0), active coping (median 2.0; 25−75% IQR (interquartile range) 1.5−2.0), planning (median 2.0; 25−75% IQR 2.0−2.0), emotional support (median 2.0; 25−75% IQR 1.5−2.0), instrumental support (median 2.0; 25−75% IQR 2.0−2.0), self-distraction (median 2.0; 25−75% IQR 1.5−3.0), and venting (median 2.0; 25−75% IQR 1.5−3.0). A decision to adopt a particular stress management strategy by patients with neoplastic diseases was highly affected by demographic factors (p < 0.05), such as sex, education, age, place of residence and employment. Conclusions: Teaching stress management strategies should be a part of the education process among patients with neoplastic diseases. Before or in the course of treatment, an oncology patient should be educated on the prevention of mental health disorders. The ability to cope with stress is one of the key competences for the course of neoplastic diseases and it can affect the treatment process. Stress management in chronic diseases, including neoplastic diseases, should be approached not only at the level of an individual person but also at the level of the health system as a whole.

Effects of Stigma on the Relationship Between Perceived Social Support and Sexual Satisfaction Among Breast Cancer Survivors

BACKGROUND

Sexual satisfaction is one of the issues faced by breast cancer survivors (BCSs).

AIM

This study aims to explore the mediation of stigma in the relationship between perceived social support (PSS) and sexual satisfaction among breast cancer survivors.

METHODS

A cross-sectional study was conducted among 918 BCSs in Shanghai Cancer Rehabilitation Club. Data were collected using an online questionnaire including questions on sociodemographic characteristics, health status, PSS, stigma and sexual satisfaction of participants. The bootstrap method was used to test the significance of the simple mediation model.

OUTCOMES

The simple mediation of stigma was found significant in the relationship between PSS and sexual satisfaction.

RESULTS

Stigma plays an intermediary role in the relationship between 2 dimensions of PSS (family and friends) and sexual satisfaction, but not in the relationship between the dimension of other significant people of PSS and sexual satisfaction.

CLINICAL TRANSLATION

It is important to reduce stigma when improving the sexual satisfaction of BCSs from the perspective of PSS.

STRENGTHS & LIMITATIONS

The mediating role of stigma in the relationship between PSS and sexual satisfaction among BCSs has been shown for the first time. Study limitations include limitations in the representativeness of population by the study sample and the cross-sectional study design.

CONCLUSIONS

Stigma mediates the relationship between PSS and sexual satisfaction, which needs to be eliminated in intervention practice. Yuxin Zhang, Jie Zhao, Nan Jiang, et al. Effects of Stigma on the Relationship Between Perceived Social Support and Sexual Satisfaction Among Breast Cancer Survivors. J Sex Med 2022;19:1002-1011.

Perceived Stigma and Its Correlates Among Asian Patients with Advanced Cancer: A Multi-Country APPROACH Study

OBJECTIVES

Perceived cancer-related stigma can affect mental health and potentially treatment choices for patients with cancer. Nevertheless, perceived stigma is not very well understood in Asia. This study investigated across six developing Asian countries: 1) the prevalence of perceived stigma among advanced cancer patients, 2) its risk factors, and 3) its association with patient treatment preferences.

METHODS

This cross-sectional study recruited patients receiving oncology care across major hospitals in Bangladesh, China, India, Philippines, Sri Lanka and Vietnam. Participants (N = 1358) were adults diagnosed with stage IV metastatic solid cancer who completed self-reported surveys. Multi-variable logistic regression and ordered logit models examined the associations with perceived stigma and variables of interest.

RESULTS

Across the countries, 35%, 95% CI [32%, 38%] of patients reported experiencing at least one facet of cancer-related stigma often or always, while 60% [57%, 63%] reported it occurring occasionally. Top-endorsed facets of perceived stigma across the Asian countries suggest a distinct pattern. Having knowingly engaged in health-risk behaviours (OR = 2.03-2.24, 95% CI [1.14-1.19, 3.43-4.41]), unemployment (2.64 [1.67, 4.19]) and body image change (1.57 [1.00, 2.45]) were associated with higher odds of perceived stigma, while time mitigated perceived stigma (0.49-0.65 [0.30-0.45, 0.76-0.92]). Perceived stigma was associated with lower odds of preference for life-extending treatments, although the associations did not hold up in the adjusted model.

CONCLUSIONS

Perceived stigma is unique among Asian advanced cancer patients. Stigma is important to assess and address, taking into consideration the various sociodemographic, clinical and psychological factors of cancer patients. This article is protected by copyright. All rights reserved.

Evaluating a Pilot Culturally Sensitive Psychosocial Intervention on Posttraumatic Growth for Chinese American Breast Cancer Survivors

This study investigated the potential benefit of a pilot culturally sensitive group support intervention, named Joy Luck Academy (JLA), in fostering posttraumatic growth among Chinese American breast cancer survivors. Eighty-six Chinese American breast cancer survivors participated in an eight-week single-arm pre-/post-test trial of an intervention program, which included educational lectures and peer mentor support. The JLA participants were compared with an independent sample of 109 Chinese American breast cancer survivors who went through routine care. Both groups completed baseline and eight-week follow-up assessments of the five facets of posttraumatic growth (meaningful interpersonal relationships, finding new possibilities in life, personal strength, appreciation of life, and spirituality). From baseline to follow-up, the JLA participants displayed significant improvements in the total score of posttraumatic growth, meaningful interpersonal relationships, appreciation of life, finding new possibilities in life, and personal strength. In contrast, the routine care participants showed no significant change in any of these outcome variables. The findings suggest the potential benefit of a culturally sensitive group support intervention in facilitating posttraumatic growth for Chinese American breast cancer survivors, indicating the need for a randomized controlled trial. The educational lectures and peer mentor support may be adapted to tailor the needs of other ethnic minority cancer patients.

Impact of stigma and stigma-focused interventions on screening and treatment outcomes in cancer patients

Background

Stigma is known to negatively influence cancer patients’ psychosocial behaviour and treatment outcomes. The aim of this study was to systematically review the current data on cancer-related stigma across different populations and identify effective interventions used to address it.

Methodology

The protocol, search, appraisal, synthesis, analysis and reporting framework was used for conducting this systematic literature review. CINAHL, PubMed, PsycINFO and Google Scholar databases were searched using the different combination of keywords that include ‘cancer stigma’. Articles publication period was set for 2010–2020. A total of 54 articles (31 quantitative, 19 qualitative, 2 mixed methods and 2 scoping reviews) that met inclusion criteria were reviewed out of the 958 articles initially identified. Quality assessment of included studies revealed the studies had varying levels of methodological quality. Extracted data were organised and narratively analysed.

Results

Cancer stigma was expressed across different segments of the society including amongst the elites and healthcare providers. Developing countries had higher rates of stigma reported and experience of stigma varied by cancer type. Cancer was consistently associated with imminent death in all studies reviewed. Cancer patients experiencing stigma were more inclined to conceal their diagnosis and to seek medical help later. Whilst cancer stigma majorly resulted in negative psychosocial outcomes in patients, there were also instances of posttraumatic growth emanating from the stigma experienced. Literature on cancer-related stigma interventions was scant.

Conclusion

Cancer related stigma remains high in both clinical settings and amongst the general public. There is need for more interventions to combat cancer stigma and its effect in both patient and non-patient population. Anti-cancer public enlightenment campaigns should be sensitively designed to not further fuel stigma against patients with certain types of cancers.

Experiences and perspectives of suffering in cancer: A qualitative systematic review

PURPOSE

Suffering refers to a situation in which a person's illness and condition threaten their integrity. The aim of this systematic review was to synthesize qualitative studies that explored suffering of persons with cancer.

METHOD

A qualitative systematic review was conducted. Psych Info, PubMed, and CINAHL were searched for relevant studies. Methodological quality was independently assessed using the Critical Appraisal Checklist from Joanna Briggs Institute (JBI). A meta-aggregative approach was utilized to analyze and synthesize the data that focused on how persons with cancer perceive suffering across their illness trajectory.

RESULTS

Twelve articles reporting the experiences of 230 participants were synthesized. Three synthesized findings were generated from the articles: suffering the loss of normality, suffering in relation to others and existential suffering. Suffering affects the person's normal activities of life and cause the loss of normality. Suffering in relation to others refers patients' suffering also impacts on and is impacted by those around them. The last synthesized finding refers to impact of suffering on patients' whole sense of being. In addition, feelings of hopelessness, and other mental anguish are inevitable responses that lead the patients to think about death. The overall methodological quality resulted in a ConQual rating of moderate for the synthesized findings.

CONCLUSION

The persons' suffering not only affects themselves but also others, particularly close relatives. The suffering experienced is complex and goes well beyond the immediate impact of physical symptoms and treatment.

Stigmatization, discrimination and illness perception among oncology patients: A cross-sectional and correlational study

PURPOSE

Many individuals who get cancer may be exposed to stigmatization from their close relatives and their entourage. This cross-sectional and correlational study was conducted in order to determine stigmatization, discrimination and perception of illness among oncology patients in Northern Turkey.

METHOD

The sample of the study consisted of 367 inpatients who were hospitalized in the oncology and hematology clinics of a University Hospital in northern Turkey between 31.01.2019 and 30.07.2019. Data were collected using the demographics form, Cataldo Lung Cancer Stigma Scale and Illness Perception Questionnaire.

RESULTS

The mean total score of the patients according to Cataldo Lung Cancer Stigma Scale is 30.4 ± 8.8. In this study, no statistically significant relationship was determined between Cataldo Lung Cancer Stigma Scale total score and Illness Perception Questionnaire sub-dimension scores (p > .05). It can be said that the oncology patients were exposed to stigmatization and discrimination, and that certain socio demographic and clinical characteristics such as sex, marital status, education level, employment status, diagnosis, and the clinical phase of the disease are significant predictors of Cataldo Lung Cancer Stigma Scale scores.

CONCLUSIONS

In order to help them express their feelings in oncology patients, reduce their anxiety, increase their adaptation to their illness and treatment, help them cope with the multi-faceted crisis caused by the disease and improve their quality of life, cancer stigmatization should be evaluated objectively.

Self-stigma and quality of life among Chinese American breast cancer survivors: A serial multiple mediation model

OBJECTIVE

Despite the increasing scholarly attention toward self-stigma among Asian breast cancer survivors, research is limited about the underlying psychological mechanisms by which self-stigma may influence quality of life for this population. The present study investigated how self-stigma is associated with quality of life among Chinese American breast cancer survivors by examining the serial mediating effects of concerns about breast cancer, self-efficacy for coping with cancer, and depressive symptoms.

METHODS

Chinese American breast cancer survivors (n = 112) completed a questionnaire packet assessing self-stigma related to breast cancer, concerns about breast cancer, self-efficacy for coping with cancer, depressive symptoms, and quality of life. Path analysis was conducted to test the hypothesized serial multiple mediation model.

RESULTS

The hypothesized model was supported: self-stigma was negatively associated with quality of life through concerns about breast cancer, self-efficacy, and depressive symptoms. After the mediators were controlled for, the direct effect of self-stigma on quality of life was no longer significant.

CONCLUSIONS

Our findings suggest that concerns about breast cancer, self-efficacy for coping, and depressive symptoms are important pathways through which self-stigma may influence quality of life among Chinese American breast cancer survivors. Healthcare practitioners should be aware of survivors' self-stigma and make efforts to alleviate survivors' excessive cancer concerns, facilitate their self-efficacy, and offer emotional support to improve quality of life for this population.

A scoping review of return to work decision-making and experiences of breast cancer survivors in Korea

PURPOSE

Return to work (RTW) is an important component of cancer survivorship for individual rehabilitation and economic development. The focus of prior research on cancer survivor RTW has generally been on Western and general cancer populations. There is a need to examine the existing research on RTW decisions and experiences in Korean breast cancer survivors (BCS).

METHODS

This scoping review followed the framework of Arksey and O'Malley, which consisted of identifying the research question, discovering and selecting studies, charting data, analyzing results, and incorporating expert consultations. Quality assessments and a thematic map were included.

RESULTS

Out of 863 original articles found in the literature search, 8 articles met the inclusion criteria. Majority were published in the past 5 years. The scope of the field, socio-demographic and clinical associations, and factors associated with RTW decision-making and experiences were reported. In the thematic analysis, 4 main categories were derived.

CONCLUSIONS

Future research needs to be conducted on effective RTW interventions targeting various educational backgrounds, socioeconomic levels, and job types. More institutional and social support would encourage more successful RTW through educational awareness, financial assistance, and workplace accommodations. Future studies should focus on interdisciplinary RTW efforts with multiple stakeholders.

IMPLICATION FOR CANCER SURVIVORS

BCS need programs that include social support, individual coping strategies, reliable RTW information, physical rehabilitation, vocational counseling, workplace allowances, and psychological support. More support should be provided through extending the work law and engaging employers. If they desire to resume working, BCS should be fully supported with RTW specific resources.

Cross-cultural validation of the Cancer Stigma Scale in the general Japanese population

BACKGROUND

The stigma associated with cancer has negative impacts on cancer patients as well as the general public, who have a potential risk of cancer. To the best of our knowledge, a validated measure to assess cancer stigma among the general Japanese population does not exist.

METHOD

We translated the Cancer Stigma Scale (CASS) - a 25-item self-administered scale to evaluate stigma related to cancer - into Japanese and examined its psychometric properties. The Japanese version of CASS (J-CASS) was validated among a sample of the general Japanese population through an online survey to validate its test-retest reliability, internal consistency, and concurrent validity.

RESULTS

A total of 319 responses were included in the analysis. An exploratory factor analysis eliminated two original items but showed a six-factor model (Awkwardness, Severity, Avoidance, Policy Opposition, Personal Responsibility, and Financial Discrimination), which was similar to the original scale. Cronbach's alpha for each factor was satisfactory, ranging from 0.81 to 0.91. The internal correlation coefficients were above 0.70, except for Policy Opposition. The total and subtotal scores of each factor of the J-CASS were significantly associated with respondents' age, gender, familiarity with cancer patients, and social desirability, demonstrating the scales' good concurrent validity. A substantial proportion of the participants selected "unsure" for some items of the scale, suggesting a further need for refining the scale.

SIGNIFICANCE OF RESULTS

This study demonstrated that J-CASS is a reliable and valid measure for evaluating misconceptions and stigma toward cancer in the general Japanese population.

Tumor origin and symptom distress of radiotherapy affected fluctuation of purpose in life for cancer patients

This study was to explore the change in purpose in life (PIL) and symptom distress among cancer patients with radiotherapy and associated risk factors. This was a longitudinal study.160 patients were recruited from a medical center in Southern Taiwan. Surveys were conducted one week before and one week after the patients had radiotherapy by questionnaire. Multivariate regression analysis were performed to analyze the data. The patients had significant changes in PIL after radiotherapy compared to before. They had low PIL scores when they were at stage IV, were unable to receive surgery, had tumors in sites other than the abdominal cavity and pelvic, or had high scores in symptom distress scale. Our findings empirically demonstrated that the sense of meaning is integrally associated with the physical and psychosocial effects of illness. Given that cancer patients who are at an advanced stage, unable to receive surgery and have tumors at sites that are not the abdominal cavity and pelvis are at a high risk for having low PIL after RT, care services should be directed to the patients under these conditions.

Limited knowledge and access to palliative care among women with cervical cancer: an opportunity for integrating oncology and palliative care in Zimbabwe

BACKGROUND

Cervical cancer is mostly diagnosed at advanced stages among the majority of women in low-income settings, with palliative care being the only feasible form of care. This study was aimed at investigating palliative care knowledge and access among women with cervical cancer in Harare, Zimbabwe.

METHODS

Sequential mixed methods design was used, consisting of two surveys and a qualitative inquiry. A census of 134 women diagnosed with cervical cancer who visited two cancer treating health facilities and one palliative care provider in Harare between January and April, 2018 were enrolled in the study. Seventy-eight health workers were also enrolled in a census in the respective facilities for a survey. Validated structured questionnaires in electronic format were used for both surveys. Descriptive statistics were generated from the surveys after conducting univariate analysis using STATA. Qualitative study used interview/discussion guides for data collection. Thematic analysis was conducted for qualitative data.

RESULTS

Mean ages of patients and health workers in the surveys were 52 years (SD = 12) and 37 years (SD = 10,respectively. Thirty-two percent of women with cervical cancer reported knowledge of where to seek palliative care. Sixty-eight percent of women with cervical cancer had received treatment, yet only 13% reported receiving palliative care. Few women with cervical cancer associated treatment with pain (13%) and side effects (32%). More women associated cervical cancer with bad smells (81%) and death (84%). Only one of the health workers reported referring patients for palliative care. Seventy-six percent of health workers reported that the majority of patients with cervical cancer sourced their own analgesics from private pharmacies. Qualitative findings revealed a limited or lack of cervical cancer knowledge among nurses especially in primary health care, the existence of stigma among women with cervical cancer and limited implementation of palliative policy.

CONCLUSIONS

This study revealed limited knowledge and access to palliative care in a low-income setting due to multi-faceted barriers. These challenges are not unique to the developing world and they present an opportunity for low-income countries to start considering and strategizing the integration of oncology and palliative care models in line with international recommendations.

Validation of the Chinese Version of the Shame and Stigma Scale in Patients with Head and Neck Cancer

Purpose

Head and neck cancer (HNC) patients suffer from perceived shame and stigma due to the illness diagnosis, as well as disfigurement following surgery. To measure HNC patients' perception of shame and stigma, the Shame and Stigma Scale (SSS) was developed and preliminarily validated. In this study, we aimed to translate, adapt, and validate the SSS in Chinese.

Methods

This study consisted of a cross-sectional design with consecutive sampling and consisted of two stages: (1) translation of the SSS into Chinese by two bilingual professionals and (2) examination of the Chinese version of the SSS (C-SSS) for internal consistency, inter-rater reliability, test-retest reliability, construct validity, and concurrent validity. In total, 159 inpatients with HNC (mean age: 56.8 years, 95% males) were enrolled at a medical center in Southern Taiwan.

Results

The Principal Component Analysis of the C-SSS revealed a five-factor structure: 4 of the 5 factors were replicated in the original SSS, including Shame with Appearance, Regret, Social/Speech Concern, and Sense of Stigma; only factor 4, Self-discrimination, was newly identified in the current study. C-SSS showed acceptable internal validity (Cronbach's α =0.85), test-retest reliability, inter-rater reliability, and fair concurrent validity with the Taiwanese Depression Questionnaire (TDQ), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Explanatory Model Interview Catalogue (EMIC).

Conclusion

The findings of this study indicate that C-SSS is a reliable and valid instrument for evaluating HNC patients' perception of shame and stigma in the Taiwanese population.

Cancer-Related Stigma and Depression in Cancer Patients in A Middle-Income Country

Objective:

The aim of the current study are to determine the depression levels of adult oncology patients in the cancer treatment phase and identify both cancer-related stigma and the factors affecting their depression levels.

Methods:

In this correlational study, 303 adult patients who had been treated at a medical outpatient clinic were surveyed using the convenience sampling method. The “questionnaire for measuring attitudes toward cancer – patient version,” a sociodemographic characteristics questionnaire, and the beck depression inventory were used. A multivariable linear regression model was used for the analysis.

Results:

The questionnaire and its subscale scores indicated a positive relationship between depression and attitudes toward cancer. The predictive variables for depression were “being younger than 40-year-old” and “feelings of social exclusion,” which accounted for 4% of the total variance. Four factors indicating negative attitudes toward cancer were “being more than 60-year-old,” “higher education,” “low income,” and “feelings of social exclusion,” which accounted for 11% of the total variance.

Conclusions:

Cancer-related stigma, which underlies patients' emotional and behavioral outlooks, should be reduced in cancer patients. Members of health teams should be sensitive to cancer-related stigma.

The Illness Experiences of Chinese Patients Living With Lymphoma: A Qualitative Study

BACKGROUND

Lymphoma patients encounter many problems. Studies investigating the illness experiences of Chinese patients with lymphoma are limited.

OBJECTIVE

The objectives of this study were to explore the illness experiences of lymphoma patients in China and describe the impacts of this disease on the everyday lives of these individuals.

METHODS

A descriptive qualitative design was used. The data were collected through face-to-face semistructured interviews and analyzed using the conventional content analysis method.

RESULTS

Nine men and 7 women participated in this study. The following 6 themes emerged: (1) cancer diagnosis reactions, (2) self-image altered, (3) interpersonal relationships influenced, (4) career development hindered, (5) life philosophy changed, and (6) personal growth achieved.

CONCLUSIONS

This study contributes new knowledge to the understanding of the illness experiences of lymphoma patients within the Chinese social and cultural context. This study also reveals how these individuals cope with the complex problems they face.

IMPLICATIONS FOR PRACTICE

Nurses could help Chinese patients with lymphoma accept the disease and its treatments by emphasizing the importance of family integrity. Information, such as how to act in response to workplace discrimination, should be provided to patients by oncology nurses.

Pity: a qualitative study on Iranian women with breast cancer

BACKGROUND

Women with breast cancer (BC) are commonly confronted with others' pity. However, there is limited information about pity in Iranian women with BC. The aim of this study was to explore perceptions, reactions, coping strategies, and consequences of pity among Iranian women with BC.

METHODS

This qualitative study was carried out from March 2016 till October 2017. A purposive sample of 36 women with BC was selected with maximum variation from three health care centers in Alborz Province, Iran. Data were collected using semistructured interviews and analyzed using a conventional content-analysis approach.

RESULTS

Our findings indicated that Iranian women with BC experienced received pity and perceived unusual attention from others as due to certain reasons. Others' pity caused negative emotional reactions in them. They used self-protection strategies against others' pity. The consequences of self-protection against pity were normalizing the patient's flow of life and/or social isolation.

CONCLUSION

Pity is a serious psychosocial challenge in Iranian women with BC, with negative effects on quality of life. Therefore, pity should be considered in counseling and psychosocial screening of patients.

Ambivalence over emotional expression and intrusive thoughts as moderators of the link between self-stigma and depressive symptoms among Chinese American breast cancer survivors

Due to successful public health campaigns, breast cancer has successfully transformed from a highly stigmatized illness to a philanthropically supported disease in the United States. However, Chinese American breast cancer survivors continue to experience high levels of self-stigma and associated negative mental health outcomes. In the present study, we examined the relations between self-stigma and depressive symptoms, and further tested individual difference variables such as ambivalence over emotional expression and intrusive thoughts that may exacerbate the harmful effects of self-stigma among this population. One hundred and twelve foreign-born Chinese breast cancer survivors living in the United States completed questionnaires measuring self-stigma, depressive symptoms, AEE, and intrusive thoughts. We found significant AEE × self-stigma and intrusive-thought × self-stigma interaction effects in predicting depressive symptoms. Specifically, the relationships between self-stigma and depressive symptoms were exacerbated among individuals with high levels of AEE and intrusive thoughts. Self-stigma represents a significant predictor of depressive symptoms among Chinese breast cancer survivors, and particularly so for individuals with higher levels of AEE and intrusive thoughts. The findings suggest that for interventions designed to reduce the negative mental health outcomes associated with self-stigma, targeting risk factors such as AEE and intrusive thoughts might be promising.

Men With a "Woman's Disease": Stigmatization of Male Breast Cancer Patients-A Mixed Methods Analysis

Male breast cancer (MBC) is rare and known as a typical woman’s disease. This study is part of the N-MALE project (Male breast cancer: patient’s needs in prevention, diagnosis, treatment, rehabilitation and follow-up-care) and aims to investigate how MBC patients (MBCP) feel about suffering from a “woman’s disease,” what character the stigmatization has, and how it can be prospectively reduced. Therefore, a mixed methods design is applied including data of N = 27 qualitative interviews with MBCP and quantitative data of N = 100 MBCP. Findings identify a diverse picture, as stigmatization varies between contexts and patients: Most stigmatization concentrates on sexual stigmatization and ignorance of MBC and mostly occurs in cancer care systems and work-related contexts. The level of stigmatization varies with age and amount of treatment methods received, as reported within the created typology of different MBCP stigma types. To prospectively reduce stigmatization in MBCP, more publicity of MBC is needed, as well as gender-neutral communication and information material.

Stigma and Related Factors in Iranian People with Cancer

Introduction: Stigma is one of the psychosocial and intercultural issues that can be found in chronic diseases, including cancer. Stigma may reduce communication due to social isolation, feeling shame and others’ judgment, and these factors make far from professional services and poor health outcomes in individuals with cancer. Assessment of stigma can help determine and recognize the overall levels of stigma in the community and identify situations that need intervention. Objective: The aim of this study was to determine stigma and related factors in individuals with cancer in Iran. Methods: This descriptive cross-sectional study was conducted on 142 patients with cancer selected via convenience sampling method in two hospitals affiliated to Shahid Beheshti Medical University. A demographic as well as clinical record form and “A questionnaire for measuring attitudes toward cancer (cancer stigma) ‑ Patients version” by Cho et al., (2013) were used for data collection. Data were analyzed using descriptive statistics and regression analysis. Results: More than one quarter of participants (26.1%) had negative attitudes toward cancer and high stigma score>= 2.5. More than half of the participants (57.5%) agreed that their job performance would be reduced even after treatment. 54.5% of the patients considered it difficult to regain health after being diagnosed. There was a significant correlation between the stigma score and the level of education (p= 0.033, OR=0.78). Conclusion: The results showed that stigma in dimensions of impossibility of recovery and stereotypical aspects of cancer were more common. These findings can lead to interventions and educational efforts on cancer coherence which may help in treatment, rehabilitation and return to normal life.

Psychological distress and coping strategies among women with incurable lung cancer: a qualitative study

PURPOSE

Limited research has focused on women with lung cancer (LC) although they are recognized as the most vulnerable to psychological distress. This study explored in-depth the psychological distress experienced by women with incurable LC and analyzed the coping strategies with which they manage that distress.

METHODS

A qualitative methodology with in-depth interviews was employed for 34 women with advanced or recurrent LC. An inductive data-driven thematic analysis was applied to analyze transcripts.

RESULTS

Psychological distress was an iterative process for the women. Four themes were identified: shock regarding the diagnosis, distress regarding cancer treatment and its side effects, the facing of a recurrent or progressive disease, and persistent struggle with the life-limiting disease. Various coping strategies applied by the women to manage psychological distress were grouped into four themes: relying upon social support, focusing on positive thoughts, avoidance-based strategies, and religious faith and acceptance.

CONCLUSIONS

Women with incurable LC experienced substantial iterative psychological distress throughout the illness, regardless of length of illness at time of interview. They applied multiple forms of coping. The findings enrich the limited existing literature on this understudied population and provide direction for the future development of interventions to improve their psychological well-being.

The effect of advocacy for overcoming stigma on posttraumatic growth: Focusing on childhood cancer survivors

The aim of this study was to investigate both strategies for coping with stigma and the effects of participating in advocacy. The participants were childhood cancer survivors who had been diagnosed before the age of 18 years who had completed treatment. An embedded-design mixed-methods approach was used with 30 interview scripts, and 145 survey results were collected. Coping strategies for the stigma of cancer were "secrecy, avoid stereotypes, and discrimination" and "disclosure of medical history." Participation in advocacy confirmed self-worth, helped in achievement, and promoted social skills. Quantitative analysis showed that greater advocacy participation was associated with higher levels of posttraumatic growth. This study could provide support for advocacy among childhood cancer survivors by demonstrating its positive effects.